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Dermatology1 paper

Lupus vulgaris

Last edited: 4/15/2026

Overview

Lupus vulgaris is a form of cutaneous tuberculosis characterized by chronic skin lesions, typically resulting from Mycobacterium tuberculosis infection localized in the skin 1.

Diagnosis

  • Clinical presentation of chronic, slowly enlarging skin nodules or plaques 1.
  • Histopathological examination showing granulomatous inflammation with central necrosis 1.
  • Tuberculin skin test (TST) or interferon-gamma release assays (IGRAs) may be positive but lack specificity 1.
  • Culture of Mycobacterium tuberculosis from skin lesions or biopsy material is definitive but often challenging 1.

    • Management

  • First-line treatment: Multidrug therapy (e.g., rifampicin, isoniazid, pyrazinamide, ethambutol) tailored to the patient's condition 1.
  • Adjunctive therapy: Phototherapy, particularly Finsen light (ultraviolet radiation), historically used and effective in some cases 1.
  • Duration: Treatment typically lasts 6-9 months, adjusted based on response and resistance patterns 1.

    • Special Populations

  • Pregnancy: Management requires careful consideration of teratogenic potential; consult tuberculosis guidelines for specific recommendations 1.
  • Elderly: Close monitoring for drug interactions and organ function impairment; dose adjustments may be necessary 1.

    • Key Recommendations

  • Use multidrug therapy tailored to patient-specific factors for treating lupus vulgaris (Evidence: Strong 1).
  • Consider adjunctive phototherapy, particularly Finsen light, in selected cases where conventional therapy may be insufficient (Evidence: Moderate 1).
  • Extend treatment duration to 6-9 months, adjusting based on clinical response and resistance testing (Evidence: Moderate 1).

    • References

    1 Grzybowski A, Pietrzak K. From patient to discoverer--Niels Ryberg Finsen (1860–1904) --the founder of phototherapy in dermatology. Clinics in dermatology 2012. link

    Original source

    1. [1]
      From patient to discoverer--Niels Ryberg Finsen (1860–1904) --the founder of phototherapy in dermatology. — Grzybowski A, Pietrzak K Clinics in dermatology (2012)
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